Editor’s Note: This text is a transcript of the webinar, Communication and Independence for the Young Adult with Autism, presented by Lisa Audet, PhD, CCC-SLP.
Learning Objectives
After this course, readers will be able to:
- List 5 ways that deficits in executive functioning can influence communication and problem-solving in young adults with autism.
- List 3 ways that developmental milestones influence young adults with autism.
- List 3 societal challenges encountered by young adults with autism as they attempt to establish autonomy and independence.
- List 3 strategies that can help young adults with autism increase communicative competence and manage current socio-cultural limitations.
Introduction
I’m so glad to be talking about this important topic. As our clients with autism are aging and becoming young adults, I'm learning so much about the world that they face and I wanted to share some of that with you.
In way of disclosure, I am on faculty and I'm being paid for this webinar to present. I am the owner of Communication and Learning Consultation Services in Hudson, Ohio.
Common Ground: ASD Level 1
To create a common ground, the new DSM has just one diagnosis of autism spectrum disorder (ASD) with three levels of ASD. Level 1 includes individuals who need the least amount of support and can also be classified as with or without intellectual or language impairment. This course will focus on individuals who have been diagnosed with ASD Level 1. Previously, these individuals may have had a diagnosis of PDD-NOS or Asperger Syndrome or high functioning autism. But, the correct terminology, given DSM-5, is ASD Level 1.
Case Studies
Samantha
The first case study that I want to discuss is Samantha, a young lady who's very bright. She may have had other diagnoses, like ADHD and personality disorders when she was young, but she is very bright and was recently diagnosed at the age of 22 with autism spectrum disorder. She's currently unemployed and working through a state-managed vocational management group to gain employment. Despite her competence, her case manager tells her she will never be able to work in an office because of her autism. We will discuss that more later.
Jack
Jack is 24 and has completed his undergraduate degree in health care ethics. He, too, has a diagnosis of high functioning autism, ASD Level 1. Upon graduation, he started working for an agency working with individuals who have disabilities, but becomes very stressed as he witnesses what he perceives to be inappropriate treatment or not understanding the nature of autism. So, he returns to school to obtain his Master’s Degree. During this process of becoming a young adult, he becomes more independent making decisions, organizing his time and understanding his own needs.
Jack seeks out counseling and is working on separating from his parents, who continue to feel very protective of him and want to assist him in making his decisions. Later on, we will see what Jack does.
Jeff
The third person is Jeff, who was diagnosed with autism when he was 18 years old. This is another late diagnosis, which is not uncommon for individuals who are high functioning. Initially, he accepts his diagnosis and wants to learn more. He finally understands what's going on with him. But, to him, it's no big deal. He gets his undergraduate and graduate degree. But during an externship, he begins to experience hostility from supervisors and teachers as he discloses his autism. They begin to refuse to provide him with accommodations and communicate that he doesn't belong in the profession. He gets very upset about this, obviously, and ultimately begins to deny his autism, begins to refuse support and is unable to maintain a job. I should mention, Jeff’s undergraduate and graduate degrees are in special education. Again, we will come back to Jeff to see what happens as a result of all of this.
Social, Communication, Emotional Needs: Young Adult Developmental Milestones
The individuals in the three cases are all incredibly bright and have a lot to offer, but they meet some external challenges that aren't really of their own doing. We want to think about that as we develop social pragmatic groups, work on social skills, et cetera.
One way to begin doing that is to think about the social communication and emotional needs of typically developing young adults. What do they need? They are:
- Working very hard to become independent and solve problems on their own.
- Developing greater flexible thinking skills, which is something that may be difficult for the clients that we're working with.
- Facing gradually increasing problems, but young adults are typically developing the skills to solve those problems. Again, this is something our population may have difficulty with, yet that desire for independence is still there.
- Setting and achieving goals. Our clients may be able to set goals, but coming up with a plan to achieve them might be difficult.
- Developing close friendships and relationships, which is very important for this age group. It is very important for us to remember that even though the person has an autism spectrum diagnosis there is this desire for connecting.
- Finding meaningful work, a career, establishing themselves, having expertise.
Independence is critical for young adults. One thing to think about is our population has some innate difficulties, like executive functioning difficulties, but they may not have been coached with natural problem solving along the way, as typical young adults have been.
A typical young adult in high school has to deal with some peer pressure, they practice managing it and they're using skills that they possess. That doesn't mean that typically developing young adults don't stumble, but they may have more natural experiences than individuals who are on the spectrum.
Social-Cultural Aspects of Equity and Inclusion
Let's think about the culture in which young adults with autism are functioning, particularly aspects of equity and inclusion. Equity refers to resources and the need to provide resources so that all groups can reach comparable, favorable outcomes. If we think about that and reflect on the three case studies, especially Sam and Jeff, the culture and the context are presenting obstacles and preventing them from setting and achieving goals. They may have set up a plan to achieve the goals, but the culture is creating these artificial challenges.
Inclusion refers to internal practices, policies, and processes that shape the organization. It’s the fundamental belief, an inclusive belief, of how the members of the community view inclusion, view providing supports to others, and how they design a culture that is welcoming and supportive. The research suggests that when inclusive practices are present, everyone within the organization can begin to benefit. We are not quite there yet with our young adults with autism. But we need to get there because there will be quite a few young adults and adults with autism in the next decade who will be looking for work and looking to establish themselves in the community.
Individuals with autism may face some challenges. Unfortunately, the systems aren't created to support their achievement. There are policies and practices that may continue to infantilize or oppress those with ASD Level 1.
Examples
Here is a brief story. At Kent State University, there is a student organization of people with autism. They decide what they want to do in their student organization, et cetera. There are members of that organization who are getting their PhDs in neurobiology, or undergraduate degrees in journalism or speech-language pathology, just to name a few. The group was holding a meeting in the student center and on the door was a note indicating who is meeting in the different rooms within the student center. Three college students walked by the room, saw the note on the door indicating that the “the Autism Connections Kent” was meeting and their response was, “Oh, how cute! The people with autism have a nice group.” That is infantilizing and oppressive. All of the work that we have done to enhance social skill development in this population is not going to attack that. The students attending the meeting overheard the comments and were livid. They have talents to offer and that is an externally imposed barrier that others who might not have ASD are not facing. And it colors everything that we do and where we put our energies.
Another example is a student who shows up to talk about accommodations in the Student Accessibility Office. He says that he needs to work on organizational strategies, and the officer said, “Well, that's too bad because we don't have those here.” The officer wasn't aware that, on this very campus, we have a speech and hearing clinic that would address organizational strategies. So, there is limited knowledge within the culture of where supports might be available. This person was trying to advocate for himself by seeking out somebody who could connect them to the resources possible. But the officer wasn’t even aware that they are available.
Another example is a student who receives peer mentoring, where the neurotypical peer is being paid to help the person with ASD Level 1. Those kinds of mentoring programs really send a message to the person with autism that somebody has to be paid to spend time with them. As if they have to pay for a friend. Yet, the student with ASD Level 1 is in a Master’s program and the paid help is a sophomore. There's a real discrepancy there.
We have a different program at Kent State University where we pair people up as equals and both members of the pair can earn experiential learning credit for that. The very explicit message is that no one is better than the other. We all have to learn about the other's perspective.
A final example is an individual who is employed in an area commensurate with their degree, an architecture program, but they're not completing their work accurately or in a timely manner. The employer is really trying to provide supports to help the person improve. When the person with autism doesn’t improve and it starts interfering with productivity, the employer doesn't fire him. Instead, he lays him off and says, “We just don't have work for you to do.” This leads the person with autism to think, “It's not because I didn't have the skillset, it's because they didn't have work.” How will the person know that he needs to actually work on that skillset if he’s not told? We can understand why the employer was trying to be nice about it but was he really doing him any favors and preparing him for the workforce?
As a result of these types of situations, many young adults are frustrated, feel disconnected, and are very discouraged. If they are told by a vocational counselor, “Well, forget it. You're not going to be able to work in the statistics field because you have autism. You should probably just look at being a bagger at your local grocery store” that would be very discouraging. Additionally, those types of comments and thoughts undo so much of the work that we've been trying to do with children with autism as they grow. It’s so important to think about these factors.
Oftentimes, young adults with autism reject traditional interventions. We can't blame them because they haven’t really helped. But we tend to view these young adults as non-compliant rather than listen to why they're rejecting our intervention. They may have good reasons. I've done some focus groups with students and they repeatedly say they don't find intervention helpful because they go out into the real world and face these other challenges that are difficult for them to manage.
Executive Functions: Influence on Day-to-Day Interactions
How does executive functioning influence students with autism on a day-to-day basis? My philosophy is that we need to address executive functions explicitly and directly so that the person with autism becomes aware that these are skills that can be developed. The more they're able to develop these skills, the better they can negotiate and manage some of the challenges that they'll face.
- Organizing - This goes along with setting priorities, but is more about organizing their written work. We have individuals on campus who have excellent syntactical skills, but when it comes to tasks like writing a one-page synopsis of a 10-page paper, their synopsis ends up being 14 pages. So, it’s learning how to sift through important points.
- Self-monitoring - This executive function skill is very important and probably should be on the top of the list. It is the idea of becoming aware of one's self in order to make changes and adjustments in a realistic manner. Becoming aware of difficulties with inhibition or shifting of attention so that they can take charge of that.
- Inhibition - Many individuals with autism have difficulty "watching their words" in social situations. For them to know, as they get older, that this is a skill called “inhibition” is fairly important and they can remind themselves to inhibit, to stop and think.
- Shifting attention - Focusing on what is important right now. In the workplace, an individual might get bogged down with a detail that is irrelevant. This happens a lot in the classroom on campus. Faculty will get upset because the person with autism is focusing on a particular question that is really a minor detail in the larger picture, and faculty don't know how to handle that. Then the other students start getting on this individual student's case because he's asking all these questions and is “being annoying”.
- Emotional Regulation - Being able to stay calm when needed and adjusting emotions to match the context. We do a lot of work to help individuals with autism with emotional regulation. Unfortunately, when they enter the workforce or a college environment and they're trying desperately to connect and encountering these discriminatory barriers, it's really hard to keep it together emotionally. We hear from residential halls that students with autism will have meltdowns at night. But what we're not hearing is how the roommate has been badgering the person with autism and the person with autism doesn't have the ability to cope. Then, the person with autism is told that they need to get a single room versus a roommate being told that his behavior is unacceptable.
- Initiation - Getting started and showing up on time. Often, individuals with autism have a hard time showing up on time because they experience social anxiety, which makes them feel sick. We've had a couple of students on campus who get so anxious that they literally get stomach aches and can't get to class on time. That creates a whole other cycle of difficulties that they encounter.
- Working memory - Thinking about the past to help them solve a problem currently.
- Planning - Some individuals can create great goals but identifying concrete steps and seeing those steps as valuable to the end product can be difficult.
- Organizing - This goes along with setting priorities, but is more about organizing their written work. We have individuals on campus who have excellent syntactical skills, but when it comes to tasks like writing a one-page synopsis of a 10-page paper, their synopsis ends up being 14 pages. So, it’s learning how to sift through important points.
- Self-monitoring - This executive function skill is very important and probably should be on the top of the list. It is the idea of becoming aware of one's self in order to make changes and adjustments in a realistic manner. Becoming aware of difficulties with inhibition or shifting of attention so that they can take charge of that.
Many students with autism reject what we have to offer and say, “I’m fine. I’m fine.” But, they are not fine and are not monitoring themselves. Therefore, we need to teach younger students self-monitoring, self-awareness and self-evaluation of other executive functions that may be interfering with their success socially or academically.
Adults with ASD Level 1
Adults with ASD Level 1 have the executive functioning difficulties previously mentioned and also deal with negative self-talk. Many adults with ASD Level 1 are their own worst enemy. One young man says that he bullies himself internally. The negative self-talk is always occurring and when the world adds to that, it’s not surprising that many individuals have significant emotional difficulties, secondary psychiatric disorders, loneliness, depression, and a desire for friendships. There are difficulties with self-regulation especially when faced with outside barriers.
Conflicts
Individuals with ASD Level 1 have deficits with executive functioning that influence socialization, work skills, and academic skills. However, they also have incredible strengths and talents and a real desire to be connected with others. I am very privileged to know so many individuals with autism who would have been called “non-compliant” who have taught me so much about what they have to offer, how frequently they are misunderstood and how devastating this is to them. As a society, we have intrinsic and explicit biases, and I see it in graduate students in speech-language pathology as I introduce them to individuals who have high functioning autism. The students are always surprised that individuals with autism encounter so many challenges in their day-to-day life and that they have so much potential.
These barriers can really interfere with independence and connection, so the question becomes, “How do we mediate this internal conflict for the person with autism, and advocate to create social change?”
The Work to Be Done
There are three different, but interconnect, components with the belief that the individual is more than her ASD, just as a person is more than their diabetes or heart problem. The first component is ASD and other related conditions, second is the person’s emotional state, self-esteem, and self-acceptance, and third is the external environment that needs to be managed.
Practical Strategies to Increase Communicative Competence, Equity, and Inclusion
The first practical strategy is to listen to the person who has autism. Assist them in creating a plan to address the challenges that are meaningful to them. For example, a college student with autism was befriended by somebody in class who knew that he was very smart. It wasn't until after midterm that he realized that this friend was using him and cheating off of him. For the person with autism, this was devastating because he thought he was going to be thrown out of the university for cheating. In this scenario, executive functioning difficulties come into play. He needed to make a plan to communicate his new awareness with the faculty person and deal with the individual. Together, we drew up a plan to block all electronic communication with the other student. He met with the professor and shared emails, concrete evidence and his own awareness of what was happening. Through that process, he was able to self-advocate.
Again, this is something that should start at a young age. For example, when a student with autism tells us that it’s too loud in the cafeteria, we help them find a way to solve that problem. We don’t just say, “Go ahead and put your headphones on.” Rather, we work to make the connection between the problem and the solution.
We are a voice for our students and clients. We want to advocate for equity and inclusion when we see an external barrier. For example, if a person with autism isn't allowed to join a social group at a school because he has autism we need to speak up and say that is discrimination.
Finally, we need to examine personal biases, which I see my graduate students doing. They are starting to think about how their behavior in response to a person with autism is colored by their preconceived notions of autism, and how that can restrict their understanding of who the other person really is.
Provide Leadership Opportunities for Those with ASD Level 1
After talking with young adults with autism on our campus, I have learned that they need leadership opportunities. We can and should start earlier to provide leadership opportunities. A great example that is currently happening is the young woman with autism who is talking about environmental change and has quite a large following. She's quite a leader and has an incredible support system behind her, which many students might not have.
We can arrange activities where these individuals are the leaders. They can lead a gaming group or peer-to-peer group. In one of our campus programs that pairs individuals up as equals, one of the individuals with autism has been a member of the program for two or three semesters and he wants to help run it. He helps run it by organizing the meetings, sending out emails, etc. It’s a great opportunity for him to get some guided mentorship.
Another idea is to pair individuals with autism and without autism as equals where they can learn about each other and engage in activities of common interest. A young man on campus was a professional drummer in a rock band. His pal, who happened to be an SLP major, went to see one of his shows and she was blown away that a person with autism can play the drums in a rock band. It changed everything in terms of her relationship with him and, as a result, changed everything with him. This example is about changing the views of neurotypical individuals regarding the capabilities of a person who has autism.
Encourage people with autism to engage in personally meaningful activities. Encourage them to join a soccer team or basketball team, take a sewing lesson or belong to a chess club as an equal member of the group.
We can support them with real strategies that acknowledge the challenges, and not encouraging the larger community to do things “just to be nice”. That approach is infantilization, limits their abilities, and further ingrains our own biases about what the other person is capable of accomplishing.
Self-Assessment & Management Planning
Self-assessment and management planning is a methodology to teach self-monitoring and self-assessment that can be used with young children throughout school age, high functioning individuals, as well as adults. I work with a number of adults who use self-management plans with a goal to increase awareness of their own behavior and improve their ability to judge their behavior in a way that's commensurate with how the neurotypical world might judge their behavior. The plan also gives them some strategies for modifying their behavior.
The client and I discuss some common goals and/or target behaviors. For example, the person might want to “watch their words” or get out of bed when the alarm goes off or leave for work 30 minutes early, etc. Then, a rating scale is created so the individual can rate his performance on those goals and the person who works with them (i.e., the care provider, teacher, SLP) rates their performance. Then, the ratings are compared to each other to see if they match.
In the beginning, the client might be giving themselves high ratings, thinking that they are doing really well and don’t really need to work on the goals. Meanwhile, the caregiver is giving them low ratings. If that is the case, then that is a point of conflict that needs to be addressed so that the client understands why there is a discrepancy in scores.
When the person with autism and the clinician/teacher start rating goals the same, around a 3, then that is pretty good. I like to see ratings of 4 and above and in agreement, but if I rate the individual a 4 and they rate themselves a 5, that is fine. It’s when I rate the individual a 3 and they rate themselves at a 5 that the goal/behavior needs to be addressed.
We also draw up a contract and the individual rewards themselves. Points earned refers to the number of points the individual wants to earn. Typically, I suggest needing to receive 80% of their points in order to cash in the points and get their reward. It's not a reward that I give to them. It’s something that they want to do for themselves to acknowledge that they did well.
Instead of having the individual rely on extrinsic reinforcement, they begin to develop that positive self-talk and some intrinsic control and intrinsic reinforcement. For typically developing children, it’s referred to as resilience. Resilient students have a great deal of intrinsic control and intrinsic reinforcement. They're not just relying on the world to tell them that they're doing great. If they have a hard time, they assess and make a change. I'm not sure we work on that kind of resilience in traditional social skills training with students who are on the spectrum. At least not yet.
Self-Regulation
How is self-regulation taught? A lot is being done with deep breathing, mindfulness, and yoga. But something I've been using in my practice is positive self-talk. Initially, individuals would say that we shouldn't teach children with autism to self-talk because they'll use that self-talk as a form of stimulation (i.e. "stimming"). However, this is not what I am referring to. I'm talking about the self-talk that you and I do every day to get through our days, to make a plan, to get the children out of the house on time, etc. It's not mindless. There’s a lot of planning and self-talk to, for example, get two children under the age of 10 out of the house and get yourself to work on time. There's so much going on in our heads, and we need to make it explicit for the person with autism that the way that people achieve their day-to-day goals is they talk to themselves. They use those executive functions to make a plan and stick with it. When they encounter difficulty, they use self-talk to soothe themselves, “It's okay. I'm going to keep going. I'm not going to worry about this. I don't really care what he said. I'm going to keep moving. Look how far I've come.” That's the kind of self-talk that I'm referring to.
I used to have a recipe box with self-talk cards for our individuals with high functioning autism (now we can use an iPad). But it’s a great method to use so that if the student is taking a test, for example, they would go to the recipe box, look under “T” for test-taking, and all of the statements and phrases that they should be saying to themselves are listed on the card. The goal is to teach individuals with autism a skill that everyone is practicing every day. On a day-to-day basis, every person activates their executive functions through self-talk. We get from point A to point B by engaging in self-talk, by making a plan, and by evaluating.
We can't assume that individuals with autism who have executive functioning difficulties are automatically engaging in this self-talk. Again, when I first introduced this concept years ago, there was a lot of pushback and suggestion that this was going to cause them to use self-talk to stim. But that was really missing the point. I'm talking about the self-talk that we engage in on a day-to-day basis that says, “Okay, I have 15 minutes to get both kids in the car. I'm going to forget about the dog right now, and I'm going to get everyone moving. I’ll carry their shoes, put their shoes on when we get to the daycare…” We do this in our day-to-day life. This is all executive functioning work and it helps us to stay motivated and to keep moving forward. If we run into a problem, we can reframe the last part. We can reframe it and say, “That's okay. No big deal. I'm going to keep moving forward.”
Again, I'm not so sure our folks with autism know how to do that and know how to keep it going. You may have technology that you can use to have a file of self-talk lines that an individual with autism can pull up for different contexts. It’s like an offshoot of social stories. I mentioned the test-taking one-liners that a student could use such as: read the question, think about the answer, put something down, move on, I'm doing great.
Another example is a person with autism having a conversation with friends, the one-liners for self-talk might be: watch my words, only give compliments, look at their eyes. It might be three one-liners for different contexts that the person can use because these are things that we do. When we feel anxious, we talk to ourselves. But because it's all internal, a person with autism might not even know that we're doing it or that it's something that people do to help them manage their emotional state and to execute plans.
Samantha, Jack & Jeff - Revisited
Let's go back and look at Samantha, Jack and Jeff. Samantha and Jack end up doing quite well. Samantha doesn't listen to her job coach. She pursues and complains about it. She advocates for herself, gets a different job coach and is able to obtain a job that is commensurate with her skill level. Her new job coach is supportive of her self-advocacy skills and really listens to her.
Jack goes into counseling and talks with his counselor about boundaries. What a great topic for young people in their late teens and early 20s. He wanted to establish boundaries with his parents, and he was able to articulate that his parents don't get it because they've worried about him for so long. Now he’s engaged in a process that is so healthy for a young person.
Unfortunately, Jeff listens to the people who are putting the obstacles in front of him, and he moves away from home. Additionally, despite having a Master’s degree in special education, he gets a warehouse job and has no friends. He argues with his family that he does not have autism. He is depressed and angry, and continues to encounter real challenges of loneliness and feeling unworthy. Hopefully, Jeff can get the support that he needs because when he was accepting his autism, things were going quite well for him. He was actually presenting in conferences about what it meant to be a person with high functioning autism. Unfortunately, the environmental barriers that he encountered really shot that all down.
That's really important for us to consider in our work. If we can keep in mind those three circles discussed earlier, that can help keep us in tune with the fact that people are operating from biases that create unnecessary challenges for a population that might be working really hard to do their very best.
Questions and Answers
What are your thoughts on the Netflix show, “Atypical” about the young adult with autism? I think it is a great presentation and I really enjoyed the show.
Yes, I really enjoyed that show too. For those of you who haven’t seen it, a young man is a high school student, and he has a girlfriend. There's quite a bit of conflict between the parents. The mother is quite protective of him and his limitations, and his mom is working so hard to make sure everything just goes smoothly. You can really feel for her. But his father is more about supporting his son in taking some risks. As I watched the show, that dilemma between the parents and their desire to do what's right and coming from two different perspectives was really interesting. We see that the son really aligns more, ultimately, with the dad, because the dad believes in him, I would say.
Another show is "Parenthood”, that portrays autism in really looking at what individuals with autism can do and how we need to change our perspective and stop putting in so many biases. To start really thinking about the kind of intervention that we provide as speech-language pathologists.
Can you share some goals for executive functioning for school-age children?
Yes, if you think about the executive function of initiation, and helping a student get started, it might be that the individual will begin their work within X amount of time. , Then we could measure from the time that the directive was given for the student to take out their work until the time the student actually took out the book. We're measuring if they succeeded in getting their book out within one minute of being told to do it. That would be the goal.
But the method would be to explicitly tell the student, “We need to work on this and what strategies will help you?” Most of the time, the student's going to think they don't need help with this task. But if they have a Fitbit or anything with a timer, they can time themselves and see, “Oh my gosh, yeah, I got to get going. I only have a minute and I'm now at 45 seconds.” That may be a useful method for helping them learn how to initiate.
Another goal would be complimenting friends. “The student will provide at least two compliments when engaged in a structured conversation.” Then we have to work with our students on what a compliment would be.
What are your thoughts on how to incorporate similar techniques for individuals who do have intellectual disabilities and language impairments?
The basic thing to do in that situation is to reduce the vocabulary complexity and make it more concrete. For example, I have a young man who tries desperately to befriend a young woman that's in a book club that I run for young adults with autism. He has very immature ways of trying to gain her attention. He'll shake the table, he'll call her different Disney characters and it annoys her. It's kind of the way that third graders try to attract people that they like - they annoy them, pull their hair, etc.
But we really want to break it down to, “Let's stop. Look at her face. What is her face telling you? I know you want to be her friend (providing validation). We need to say nice things to her.” Then the next week, start some social stories for him on how to move that forward. Being very concrete with individuals is very helpful.
How do you define independence versus autonomy? Should we ask our clients how they define those terms?
Absolutely, we should ask them how they would define them. I think there is a spectrum of independence and of autonomy. To me, autonomy means being able to decide for one's self what they want to do. Independence is being successful at completing the tasks that one chooses to do on their own. So, autonomy is more of a decision-making approach or term, and independence is the action. I think it's important to ask our students what would they like to do on their own.
Do you have any thoughts on how to broach the subject of social skills with a new client who seems to have little awareness of his need to address conversational skills?
I would start out by asking them questions about friendship and how they define friendship. What things do friends do that you like and what do they do that you don’t like. What would they like to see change in terms of friendships. If we take a teenager, for example, who likes to have a sense of identity. You may ask them what they think of their classmates. What do they think classmates thing of them? What would be some words they would use to describe them? Those are good wasy to start that conversation and think about identity.
At the beginning of this course, you mentioned that people with autism desire connection, but don't have the skills to facilitate them. When I was working in a high school, students would tell me that they didn't care about having friends or being close to people and that they were happy being alone. I found it difficult to motivate these students. Do you have any advice about that?
When we're working with high schoolers, they are all about identity and often our therapy communicates to them that they're useless. So I would flip that idea and ask them to start identifying their strengths and how they might use their strengths and interests to achieve individual goals. You might be saying to them (in so many words), “You want what I have to offer you, right?” But they're saying, “No, I don't really need that, thank you.” But if we think about what Erikson says about identity and teens, it really makes sense that they reject. Remember, these are kind of the non-compliant students we talked about earlier. If we start listening to them and say, “Wow, you're okay being alone? What do you do when you're by yourself? What makes being alone better for you than being with friends?” We might get some interesting statements from them about how hard it is and how they see friends as being stupid or mean and life is just better being alone because it's just too hard.
How do you teach flexible thinking?
If you're working with young children and teaching flexible thinking, we start at a concrete level. For example, we may use barrier games with some of language students to work on vocabulary, giving and following directions. But we can take a shift on that and use those kinds of activities to ask, “ What do you think I see? How do you know what I see? Let me guess what you see from your perspective.” We can start at a pretty concrete level to demonstrate that people see things differently. A great fall activity for young students is painting faces on pumpkins. If you put a pumpkin in front of a young student and say, “What do you think I see?” They might not know that you see a face. The idea is to teach guessing versus knowing. Putting an item in a box and shaking it and saying, “You don't know what's in the box. You need to guess what's in the box.” At a very basic vocabulary level, many young children don't have that kind of metalinguistic language of guessing versus knowing.
Another example, if you're working with older children, is to view appropriate sitcoms or clips from movies and pausing them at certain times where characters have different ideas or thoughts. There are tons of online video options and social communication clips that you can use for this where we pause and ask the student what are the two different individuals thinking
What do you think is the primary reason young adults with ASD reject intervention?
I will share what young adults have told me. They are tired of being told that there's something wrong with them. That is, unequivocally, the answer I get when I ask, “Why do you reject intervention?” I have had a number of people say that they're tired of being infantilized. Those are pretty humbling words coming from people who have really great intellectual skills and have the desire to serve in the workforce. Hearing that this is how they feel about things can make you stop in your tracks after you've been doing something for 30 years.
Citation
Audet, L. (2020). Communication and Independence for the Young Adult with Autism. SpeechPathology.com, Article 20350. Retrieved from www.speechpathology.com.
